Sudden Cardiac Death and Myocardial Ischemia Indicators

Abstract

The postmortem diagnosis of acute myocardial infarction represents a current challenge for forensic pathologists, particularly when death occurs within minutes to a few hours after the ischemic insult. Among the adult population the single most important cause of sudden cardiac death (SCD) is the well-known atherosclerotic coronary artery disease, commonly asymptomatic or unrecognized. The recognition of early myocardial damage using routine hematoxylin and eosin (H&E) staining is possible only if death has occurred at least 6 hours after the onset of the ischemic injury. The usefulness of immunohistochemical markers to the diagnosis of early myocardial damage has been recently suggested because most of them can be visible even serologically as early as few minutes after the beginning of the symptoms. To evaluate the usefulness of plasma and cellular antigens, their distribution patterns have been studied among a group of 18 SCD cases in which a myocardial ischemia was strongly suspected. For the present study, 4 markers have been selected on the basis of their different diagnostic potential as follows: among the plasma markers the C5b-9 and fibronectin, among the cellular markers the myoglobin and cardiac troponin. The results show that only the study of multiple markers such as those selected can provide enough evidence of myocardial ischemia and/or necrosis, supporting the final diagnosis of SCD. No single immunohistochemical staining is ideal for diagnosing early myocardial ischemia but a set of markers can improve the ability of forensic pathologists to detect ischemic areas when no macroscopic or microscopic evidence of necrosis is available. However, the interpretation of data obtained in each individual cannot be isolated from the overall assessment of the factors (cardiopulmonary resuscitation and/or agonal artifacts) that can affect the expression of each marker.

Immunohistochemical detection of S100A1 in the postmortem diagnosis of acute myocardial infarction

“…The temporal release pattern of these cellular proteins is dependent on the extent of hypoxia, their subcellular localization, and their physicochemical characteristics, especially molecular weight. Therefore, cellular antigens, such as MB [4], cTnI [26], and H-FABP [17], can indicate early myocardial infarction based on the loss of staining in infarcted areas.…”

“…Unfortunately, the postmortem diagnosis of AMI for forensic and clinical pathologists is difficult. Myocardial cell death does not occur instantaneously at the onset of ischemia, but takes at least 6 h before myocardial necrosis can be identified by standard macroscopic or microscopic postmortem examination, depending on the sensitivity of the cardiomyocytes [4]. Although many markers and various techniques have been introduced for postmortem diagnosis of AMI, currently, there is neither a marker nor a technique in routine medicolegal use that can solve this problem satisfactorily [4-6].…”

Potential Mechanisms Linking Atherosclerosis and Increased Cardiovascular Risk in COPD: Focus On Sirtuins

“…Human and experimental models of atherosclerosis have identified monocyte recruitment as an early event in atherogenesis. The processes of cellular adhesion, monocyte and macrophage attachment, and transmigration of immune cells across the endothelium are crucial steps in early atherogenesis and in the later stages of mature plaque rupture [15–17], as well as in inflammatory airway cell trafficking at the epithelium level [18–20]. …”

Is Physical Activity Able to Modify Oxidative Damage in Cardiovascular Aging?

“…A greater myocardial dysfunction induced by ischemia-reperfusion injury [19] represents another feature of aging process, then reinforcing the association with oxidative stress. The oxidative stress has been suggested to be also responsible for some metabolic changes.…”